Veterinary Surgery最新文献

Objective: To report demographics, clinical signs, physical examination, diagnostic test results, surgical findings, and prognostic factors for in-hospital postoperative mortality following biliary peritonitis surgery in dogs.

Study design: Retrospective, multi-institutional cohort study.

Animals: Thirty-three client-owned dogs.

Methods: The medical records of dogs that underwent surgery for biliary peritonitis between 2015 and 2021 were reviewed. Dogs were included if they had a definitive diagnosis of biliary peritonitis and a surgery report. Information on demographics, clinical signs and duration, physical examination findings, laboratory and diagnostic imaging results, surgery, perioperative medical treatment, and complications for each patient was obtained. Statistical analyses were performed to identify risk factors that affected survival.

Results: Cholecystectomy was the procedure most frequently performed (31/33, 94%). The overall mortality rate was 36% (12/33). Survival was affected negatively by hyperbilirubinemia (p = .049), administration of vasopressors (p = .002), renal dysfunction (p = .008), and number of postoperative complications (p = .005). A mortality rate of 50% was observed in dogs with a total bilirubin level greater than 60.5 μmol/L. There was no difference in mortality rate between septic and nonseptic biliary effusions.

Conclusion: New prognostic factors associated with in-hospital postoperative mortality in dogs treated surgically for biliary peritonitis were identified, while others that had been reported previously were confirmed. A preoperative bilirubin threshold value associated with a 50% mortality was identified.

Clinical significance: Additional information that could help to predict survival in dogs with biliary peritonitis has been provided. However, further research is warranted.

Objective: To assess the effect of screw thread direction on rotational resistance in canine sacroiliac (SI) luxation models using left- and right-handed screws.

Study design: Controlled laboratory study.

Sample population: Twenty-four adult canine pelves with proximal femora were examined.

Methods: Four groups (n = 6 each) were established: right-handed screw/right SI luxation (RhRSI), right-handed screw/left SI luxation (RhLSI), left-handed screw/left SI luxation (LhLSI), and left-handed screw/right SI luxation (LhRSI). Under fluoroscopy, 2.4 mm cortical screws were placed into the SI joint in a lag fashion. An acute failure test measured force and torque at yield and peak points, with the ilium and femur positioned at a 108° angle and displacement at 0.099 cm/s. Torque (N cm) was calculated from force (N) and the moment arm (cm).

Results: Differences in median torque were found at yield and peak points. RhRSI gave 50.08 N cm versus 16.01 N cm for RhLSI (p < .01), and LhLSI showed 39.42 N cm versus 19.93 N cm for LhRSI (p < .03). At peak, RhRSI recorded 67.55 N cm compared to 28.14 N cm for RhLSI (p < .01), and LhLSI reached 51.79 N cm versus 28.28 N cm for LhRSI (p < .05). All samples failed by rotation without screw breakage or fractures.

Conclusion: Right-handed screws provided greater rotational resistance in right-sided luxation, and left-handed screws in left-sided luxation, which demonstrated that screw thread direction influenced fixation stability in SI luxation.

Clinical significance: The findings suggest that selecting screw thread direction can enhance biomechanical stability in SI luxation repair, improving surgical outcomes for affected dogs.

Objective: To assess outcomes of dogs with side-to-side portocaval extrahepatic portosystemic shunts (PC-EHPSS) and poor portal perfusion to the liver treated with medical management alone (MM) or surgical attenuation (SA).

Study design: Multi-institutional retrospective study.

Animals: A total of 21 dogs with PC-EHPSS (14/21 MM and 7/21 SA).

Methods: Medical records were reviewed, and data was collected on dogs <12 kg with PC-EHPSS treated with MM or SA between June 2008 to June 2021. Signalment, clinical signs, postoperative complications, bloodwork values, long-term clinical outcome, survival, and owner reported quality of life were recorded.

Results: Of 21 dogs included, 10 were mixed breeds and 14 were females. Median age at time of presenting clinical signs was 163 days. At final follow-up examination (median 1119 days), all SA and 6/14 MM dogs were alive, with a median survival time of 2138 days following treatment onset. In surviving MM dogs, outcome was fair in 3/6 and poor in 3/6. In SA dogs with long-term follow-up, outcome was fair in 5/6, and poor in 1/6. A greater proportion of SA dogs had improved bloodwork parameter values at final follow-up examination, and the mean relative change in final bloodwork values was higher when compared to MM dogs.

Conclusion: These findings demonstrate that SA has improved clinical outcomes to MM for PC-EHPSS; however, SA clinical outcomes appear worse than those previously reported for other EHPSS.

Clinical significance: This information may have implications for expected outcomes in other EHPSS subtypes associated with severely diminished portal perfusion.

Objective: To investigate the relationship between physical attributes and difficulty performing laparoscopic maneuvers with the prevalence of self-reported musculoskeletal injury.

Study design: Online survey.

Sample population: Surgeons (n = 140) with 3 or more years of laparoscopic experience.

Methods: Electronic survey distributed via LISTSERVEs and Facebook groups. Responses collected included surgeon attributes, presence of musculoskeletal injuries, and surgical practice data. Statistical analysis was performed using the Shapiro-Wilk test, linear regression, logistic regression, and Wilcoxon rank sum tests.

Results: A total of 52 of the 140 respondents reported a musculoskeletal injury with 38 specifying at least one injury (72%). Neck strain was the most prevalent reported musculoskeletal injury (18/52, 34.6%), followed by shoulder tendinopathies (16/52, 30.8%), arm/hand tendonitis (8/52, 15.4%), carpal tunnel (7/52, 13.5%), back pain (4/52, 7.7%) and arm/hand arthritis (1/52, 1.9%). Women were significantly more likely to report a musculoskeletal problem than men (p = .011) with the odds of women reporting a musculoskeletal injury 2.59 times greater than men. Women and surgeons with smaller glove sizes were significantly more likely to report shoulder tendonitis (p = .034, p = .1) and neck strain (p = .009, p = .001). Respondents with a musculoskeletal problem experienced significantly more difficulty using rotating cup biopsy forceps (p < .001) and perceived this as difficult a greater amount of time (p = .006).

Conclusion: Female surgeons report more musculoskeletal injuries than their male counterparts. Surgeons with musculoskeletal injuries experience more difficulty performing particular laparoscopic maneuvers.

Clinical significance: Improving ergonomics for women and surgeons with smaller glove sizes must be prioritized to improve surgeon health and laparoscopic instrument use.

Objective: To compare the efficiency and accuracy of freehand and three-dimensionally printed (3DP) guide-facilitated fluoroscopic-assisted Kirschner wire placement in the femoral capitis performed by novice and experienced surgeons.

Sample population: 3DP models of five skeletally immature dog femurs were replicated.

Methods: Virtual surgical planning was done to position three parallel, virtual Kirschner wires inserted from the lateral subtrochanteric surface of the femur, coursing proximomedially through the femoral neck to engage the central capitis without penetrating the subchondral bone. Patient-specific guides were designed and 3DP to facilitate optimal Kirschner wire placement in each femoral model. Four faculty surgeons and four surgery residents performed freehand fluoroscopic-assisted wire placement in the femoral models. Wire placement was repeated ≥1 month later using the 3DP guides. Surgical time, number of times wires were redirected, number of fluoroscopy images acquired and Likert scores from the participants were recorded. Post-procedural CTs of the femur models were used to assess wire placement by 3D analysis.

Results: The number of fluoroscopy images was greater (p < .001) and procedure time was longer (p < .001) for freehand applications, while Likert scores were greater (p < .001) for 3DP-guide applications. Wire placement was more accurate with 3DP guides. Subchondral bone penetration occurred more frequently during freehand applications (p < .01).

Conclusion: 3DP patient-specific guides resulted in faster, simpler, and more accurate Kirschner wire placement than freehand placement for both novice and experienced surgeons. Further cadaveric and clinical studies are warranted to evaluate the utility of 3DP patient-specific guides to facilitate minimally invasive fluoroscopic-assisted femoral capital physeal fracture stabilization in dogs.

Objective: To evaluate the impact of postoperative radiographs on treatment decisions for skeletally immature dogs undergoing repair of a fractured humeral condyle.

Study design: Retrospective observational multicenter study.

Sample population: A total of 139 dogs (<12 months of age).

Methods: Medical records of dogs who underwent humeral condylar fracture repair were retrieved and analyzed. Data collected included dog's signalment, fixation method, reported client's concerns, follow-up clinical examination findings, radiographic assessment, and any documented changes to the postoperative plan.

Results: Out of the 139 cases, 23 dogs (17%) required a change in their postoperative plan. Owner concerns (OR: 7.6), prolonged use of analgesic drugs (OR: 7.9), presence of lameness (OR: 5.9), abnormal clinical findings at the time of follow-up examination (OR: 44.8) and radiographic abnormalities (OR: 51.9) significantly increased the likelihood of a change in the postoperative plan. Most importantly, none of these postoperative plan changes were solely attributed to radiographic abnormalities at the time of the follow-up examination.

Conclusion: Follow-up radiographs did not influence the postoperative management plan in cases where clients reported no concerns, the dogs did not require prolonged analgesic treatment, showed no lameness on examination, and had unremarkable clinical findings CLINICAL SIGNIFICANCE: In the absence of client concerns, prolonged use of analgesic drugs, lameness on examination, and clinical abnormalities, the necessity of follow-up radiographs in immature dogs that underwent humeral condylar fracture repair is debatable.

Objective: To assess the impact of a postoperative fracture gap on implant failure following radius and ulna fracture repair in toy breed dogs.

Study design: Retrospective multicenter cohort study.

Animals: A total of 80 client-owned toy breed dogs.

Methods: Medical records and radiographs were reviewed for dogs <3.5 kg that had surgical repair of simple transverse radius and ulna fractures at four institutions from 2005 to 2019. Data collected included signalment, fracture location, implant types and thickness, plate working length, evidence of a postoperative fracture gap in the caudal cortex, postoperative care, occurrence of implant failure, and other complications. The association between potential risk factors and complications was examined using multivariable logistic regression.

Results: A postoperative fracture gap in the caudal cortex was noted in 37 cases, and 10 cases experienced implant failure. Of the 43 cases without a gap, one case experienced implant failure. After adjusting for other variables, the fracture gap was significantly associated with implant failure (odds ratio = 23.0 [95% confidence interval: 2.7; 197.9], p = .004). Prolonged external coaptation was associated with minor and major complications other than implant failure (p = .04), while the absence of coaptation confounded the effects of the fracture gap on implant failure.

Conclusion and clinical significance: Reduction of the caudal cortex of the radius is imperative to promote bone healing and prevent implant failure in transverse radius and ulna fractures of toy breed dogs.

Objectives: To compare end-to-side (ES) and side-to-side (SS) jejunocecostomy (JC) in healthy horses.

Study design: Experimental study in vivo.

Animals: A total of 14 healthy adult horses underwent ventral midline celiotomy, a resection, and either an ES (n = 7) or stapled SS (n = 7) JC.

Methods: Surgical times and the external lengths of completed anastomoses were measured. Physical examinations and pain scoring were performed every 6 h for 5 days, then once daily until euthanasia and necropsy 28 days postoperatively.

Results: The anastomosis was completed more rapidly (p < .002) with the SS JC (mean 44.21 ± 4.91 min) than the ES JC (mean 54.24 ± 4.59 min). One horse in the ES group developed colic from an ischemic anastomosis and was euthanized. Three horses (1 ES JC and 2 SS JC) exhibited mild colic postoperatively, and the remaining horses had no complications. Postoperative heart rates and pain scores were similar between groups (p < .16 and p < .67, respectively). The internal length of the anastomosis was significantly larger (p < .001) in the SS JC (mean 9.27 ± 1.05 cm) than the ES JC (mean 6.31 ± 1.4 cm) at necropsy.

Conclusion: Both methods for JC were well tolerated and functional in both groups using the selected protocols for anesthesia, surgery and aftercare.

Clinical significance: This study provides evidence that both stapled SS JC and handsewn ES JC are acceptable for use in clinical cases, although additional procedures are required to maximize lumen size with the ES JC.

Objective: To describe the use of intraoperative transsplenic injection of agitated saline (TIAS) and confirm temporarily full attenuation of extrahepatic portosystemic shunt (EHPSS) in dogs.

Study design: Retrospective case series.

Animals: A total of 40 dogs.

Methods: Medical records of dogs that underwent surgical attenuation of EHPSS between January 2014 and May 2021 were reviewed. A ventral midline celiotomy was performed, the EHPSS identified and dissected, and temporal occlusion performed using Rummel tourniquets or silicone vascular loops. A wide range microconvex transducer was used to visualize the right atrium via a subxiphoid acoustic window. Agitated saline was injected into the splenic parenchyma while the right atrium was ultrasonographically monitored before and after temporary occlusion of the EHPSS. Case details, intra- and postoperative findings, and long-term outcome were recorded.

Results: The agitated saline was immediately identified within the right atrium after injection into the splenic parenchyma before temporary occlusion of the EHPSS in all cases. After temporary occlusion, the agitated saline was not observed within the right heart, except in two dogs in which a second vessel bypassing the liver circulation was identified. No intra- or postoperative complications were recorded. Long-term clinical outcome was considered good to excellent in all cases.

Conclusion: Intraoperative TIAS confirmed temporary full attenuation of EHPSS.

Clinical significance: Intraoperative TIAS is an easy, safe and reproducible technique to assess intraoperative full occlusion of EHPSS.

Objective: To determine if gonadectomy in dogs is associated with the risk of cranial cruciate ligament disease (CrCLD) and to quantify the magnitude of the association.

Study design: Systematic review and meta-analysis.

Sample population: Comparative studies with gonadectomized and entire dogs, with CrCLD as an outcome measure.

Methods: A systematic search of the primary and gray literature was performed. The effect size of the outcome measure was defined as the OR and 95% CI. Subgroup analysis was performed with sex, breed, and age at gonadectomy. A pooled OR (95% CI) was generated from meta-analysis of relevant studies. Certainty in the body of evidence was rated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Results: The literature search yielded 1398 results and 24 relevant studies were included for synthesis. Gonadectomized female (pooled OR = 2.293, 95% CI = 1.768-2.945) and male (pooled OR = 2.117, 95% CI = 1.665-2.691) dogs were both at increased odds of developing CrCLD in comparison with entire female and male dogs, respectively. Subgroup analysis showed that gonadectomy at 1 year or less was consistently associated with an increase in odds of developing CrCLD in both sexes. Overall certainty in the evidence was rated as moderate. All included studies were observational and no controlled trials were available.

Conclusion: In data with moderate certainty, gonadectomy is associated with increased odds of developing CrCLD in both sexes, particularly in dogs gonadectomized at 1 year of age or less.

Clinical significance: This study provides an estimate of the true effect size of gonadectomy on the odds of developing CrCLD, which may be useful for clinical decision making surrounding gonadectomy and the timing of gonadectomy.